Book reviewed in this article: Informed Consent in Medical Therapy and Research. By Bernard Barber.

sirAt a recent health authority meeting Professor Stacey, the NHSE Head of Research Ethics, was quoted as stating that for multicentre trials rapid responses were required ….

The title of this presentation may suggest that the subject is homocystinuria. It is not. Rather, the subject is how our epistemology influences our concept of disease, which in turn determines our ability to help patients.

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Moral responsibility theorists and legal theorists both worry about what negligence is, and how it might be a ground of blameworthiness. In this paper I argue that negligence suitably understood, can be an appropriate grounds for mens rea in rape cases. I am interested in cases where someone continues with sex in the mistaken belief that the other person consents. Such a mistaken belief is often unreasonable: a wilfully blind agent, one who deliberately ignores evidence that there is no consent, (...) is clearly not exculpated by his ignorance. However, there may be circumstances in which a man’s mistaken belief in consent is reasonable in the circumstances, then he is not culpable. Thus it is important to be clear about what we mean by a reasonable mistake. Many critics (e.g. Duff, Baron and others) have argued that it is not possible to make a reasonable mistake about consent, that any such mistake must involve culpable carelessness. Consent is so important that we should always double check. Not to do so is reckless, and in that case there is clearly culpability. In this paper I argue that it is possible to make a mistake that is reasonable, at least in one sense. Someone in the grip of sexist ideology might not understand how important consent is, and not through carelessness, but through sexist ideology that they have non-culpably and non-voluntarily absorbed. In that case it is not obvious that the man is culpable. I go on to argue that so far as the law is concerned, there is good reason to hold that even those who have ‘reasonable’ beliefs culpable. Having a reasonable belief in consent may be, but is not always exculpatory. We usually think a reasonable mistake does not count as negligence because a reasonable mistake is not failing to know something that you should have known. I argue that we should understand negligence—not knowing something you should have known—in a moralized sense, so that people who are ignorant through being ideologically blinded can be held to have the mens rea requisite for rape conviction. -/- . (shrink)

Inspired by the work of intellectual historian J. G. A. Pocock, this 1993 collection explores the political ideologies of early modern Britain.

sirFollowing Dr Barber's letter1 relating to the mechanism for approval of Local Research Ethics Committees , I have also had concerns over the intense pressure for a fast turn around for local approval. Projects may have been six months or more in the Multicentre Research Ethics Committe process and then arrive on my desk with multiple telephone calls requiring ….

This work is, in large part, a series of refutations; it is also the author's Ph.D. thesis. First to be refuted is Russell's vicious circle principle as a general remedy for the solution of the paradoxes. The author rejects the classification of paradoxes into syntactic and semantic, since in his view there are no purely syntactic paradoxes. The distinction in logic between the uninterpreted syntactical aspect of a system and the system when given a determinate interpretation is held to be (...) untenable. Tarski's distinction between object-language and meta-language and his concept of semantically closed language are considered irrelevant for the solution of the Liar paradox. The author claims that the usual versions of the Liar paradox have the same structure as the Barber paradox, viz., [S ↔ ~S]. The author solves the Liar paradox by pointing out that it does not have a proper reference. Cantor's diagonal argument for the indenumerability [[sic]] of the real numbers is labeled as unsatisfactory. Since the diagonal number is dependent upon the real numbers in the constructed list, the author claims that this makes the diagonal number to be of a different nature and status than the real numbers in the list; thus we have what the author calls the dependence fallacy. The author also refuses to accept Cantor's nested interval proof of the indenumerability [[sic]] of the real numbers. Within the proof, two infinite sequences are constructed, each of which converges to a limit. Because the proof does not give a "definite rule of convergence," the author is not satisfied that the infinite sequences converge. Also rejected is Cantor's theorem. Other paradoxes analyzed are the Berry, Richard, heterological, "Richardian", Russell, Cantor, and Burali-Forti paradoxes.--T. G. N. (shrink)

For Quine, a paradox is an apparently successful argument having as its conclusion a statement or proposition that seems obviously false or absurd. That conclusion he calls the proposition of the paradox in question. What is paradoxical is of course that if the argument is indeed successful as it seems to be, its conclusion must be true. On this view, to resolve the paradox is (1) to show either that (and why) despite appearances the conclusion is true after all, or (...) that the argument is fallacious, and (2) if the former, to explain away the deceptive appearances. Quine divides paradoxes into three groups. A veridical paradox is one whose proposition or conclusion is in fact true despite its air of absurdity. We decide that a paradox is veridical when we look carefully at the argument and it convinces us, i.e., it manages to show us how it is that the conclusion is true after all and appearances to the contrary were misleading. Quine’s two main examples of this are the puzzle of Frederic in The Pirates of Penzance (who has reachError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMapError: Illegal entry in bfrange block in ToUnicode CMaped the age of twenty-one after passing only five birthdays), and the Barber Paradox, which Quine considers simply a sound proof that there can be no such barber as is described.1 A falsidical paradox is one whose proposition or conclusion is indeed obviously false or self-contradictory, but which contains a fallacy that is detectably responsible for delivering the absurd conclusion. We decide that a paradox is falsidical when we look carefully at the argument and spot the fallacy. Quine’s leading example here is De Morgan’s trick argument for the proposition that 2 = 1. (shrink)

La educación cívica se encuentra en la misma base de la democracia . T odo sistema democrático que prescinda de esta necesidad acabará haciendo de s v anecerse la racionalidad democrática de sus instituciones. La democracia liberal es un buen ejemplo de este debilitamiento pr o g res i v o de las estructuras democráticas. Benjamin R. Barber no tarda en referirse a ella como "democracia débil". La democracia carece de plenitud sin ciudadanos fo r mados cívicamente. Educación y (...) democracia están indisol u b lemente unidas. P or eso, para este autor la r e generación de la democracia, con sus contenidos reales de pa r ticipación política, pasa necesariamente por la educación. Enseñar democracia es se r vir a la comuni dad. (shrink)

Dans quelles circonstances et pourquoi Robert K. Merton a-t-il rencontré l’idée de serendipity? Quelle place occupe-t-elle dans son œuvre? Cet article propose de reconstituer pas à pas l’histoire de cette rencontre, qui ne manque pas d’ironie ni de piquant. En elle-même « sérendipienne », la découverte accidentelle mais tellement féconde du mot serendipity ouvrit à Merton nombre de pistes de recherche au cours des années 1940. Le concept intrigant de la découverte fortuite qui – entre autres vertus – engendre des (...) résultats de nature à transformer la théorie promettait d’enrichir et de renouveler la connaissance objective. Mais la serendipity était plus qu’une recette heuristique à appliquer en science. Chez Merton, c’était aussi l’objet privilégié et « auto-exemplifiant » d’une sémantique sociologique des concepts, dont l’ambition est d’étudier les itinéraires des terminologies dans la culture. En retraçant la genèse de la recherche qu’il mena avec Elinor Barber sur l’histoire du mot et des significations parfois volatiles de la serendipity, on parviendra à saisir pourquoi ce thème revêtait pour Merton un double intérêt stratégique, à la fois épistémologique et autobiographique. On comprendra aussi pourquoi une nouvelle traduction en français du premier fragment d’article dans lequel le sociologue conceptualise la serendipity en 1948 est de bonne méthode sérendipienne. (shrink)

In 2005 St Andrews Studies published a volume of essays by Anscombe entitled Human Life, Action and Ethics, followed in 2008 by a second with the title Faith in a Hard Ground. Both books were highly praised. This third volume brings essays on the thought of historical philosophers in which Anscombe engages directly with their ideas and arguments. Many are published here for the first time and the collection provides further testimony to Anscombe's insight and intellectual imagination.

For the last 25 years, since publication of his Logical Studies, Professor Von Wright has steadily explored the field of philosophical logic. The concept of negation, logical paradoxes, the puzzles connected with evidence and probability in confirmation theory, the interrelatedness of the ideas of time and change, and the clarification of the structure of temporal and spatial orderings are among the many areas he has profitably investigated.

As Russell's paradox of "the set of all sets that do not contain themselves" indicated long ago, matters go seriously amiss if one operates an ontology of unrestricted totalization. Some sort of restriction must be placed on such items as "the set of all sets that have the feature F' or "the conjunction of all truths that have the feature G." But generally, logicians here introduce such formalized and complex devices as the theory of types or the doctrine of impredictivity. (...) The present paper argues for the informal and elementary idea that the items invoked in a proper identification have themselves already been identified. Even as an explanation is not satisfactory that proceeds in terms of items that themselves require prior explanation, so the same holds with identification. And heed of this elementary idea suffices to sideline those otherwise paradoxical perplexities. (shrink)

Henry Leonard and Karel Lambert first introduced so-called presupposition-free (or just simply: free) logics in the 1950’s in order to provide a logical framework allowing for non-denoting singular terms (be they descriptions or constants) such as “the largest prime” or “Pegasus” (see Leonard [1956] and Lambert [1960]). Of course, ever since Russell’s paradigmatic treatment of definite descriptions (Russell [1905]), philosophers have had a way to deal with such terms. A sentence such as “the..

This article presents evidence supporting the claim that ethical reasoning is a skill that can be taught and assessed. We propose a working definition of ethical reasoning as 1) the ability to identify, analyze, and weigh moral aspects of a particular situation, and 2) to make decisions that are informed and warranted by the moral investigation. The evidence consists of a description of an ethical reasoning education program—Ethical Reasoning in Action —designed to increase ethical reasoning skills in a variety of (...) situations and areas of life. ERiA is housed at a public, major comprehensive U.S. university—James Madison University—and assessment of the program focuses on interventions delivered prior to and during orientation for incoming first-year students. Findings indicate that the interventions measurably enhance the ability of undergraduate students to reason ethically. ERiA’s competency-targeted program and positive student learning outcomes offers a promising model for higher education ethics programs seeking to connect classroom learning in ethics to decision-making in everyday life. (shrink)

Disparate attempts exist to identify the key components that make an ethics pedagogy more effective and efficient. To integrate these attempts, a review of 408 articles published in leading journals is conducted. The key foci of extant literature are categorized into three domains labeled as approach, content, and delivery, and a comprehensive framework for ethics pedagogy developed. Within each of these domains, binaries that reflect two alternatives are identified. Approach, the philosophical standpoint, can be theory-laden or real-world connected. Content, the (...) constituencies addressed, can have a focus on breadth or depth. Delivery, the execution of the adopted pedagogy, can be traditional or innovative. The review of articles also identifies the lack of pedagogies that comprehensively focus on all the binaries across domains. The other substantive contribution of this article addresses this gap by developing a generic pedagogy—Integrative Live Case—based on the ACD framework. Based on an incident that is currently unfolding, this pedagogy allows integration of binaries across the three domains. It also allows for a modular course plan that can accommodate varied pedagogical preferences. Volkswagen Dieselgate is presented as a stylized example to showcase the significant advantages of using this pedagogy. (shrink)